Chapter 18  ·  Module 4
Dopamine Agonists
Drug class overview, agents, and adverse effect profile
Agents at a Glance
Pramipexole Ropinirole Rotigotine Bromocriptine
Type Non-ergot Non-ergot Non-ergot Ergot-derived
Route Oral Oral Transdermal patch Oral
Receptors D2, D3 (high D3) D2, D3 D1, D2, D3 D2
Key note Renal excretion — dose adjust in kidney impairment CYP1A2 metabolism Continuous delivery; skin reactions Fibrosis risk — not preferred
Apomorphine — Rescue Agent
Subcutaneous Injection
Apomorphine — Acute Off-Episode Rescue
  • D1 and D2 agonist — not an ergot compound
  • Onset 10 to 20 minutes — only approved acute rescue for severe off episodes
  • Highly emetogenic — antiemetic pretreatment required (trimethobenzamide)
  • Ondansetron contraindicated — severe hypotension risk
Class-Wide Adverse Effects
Class-Defining
Impulse Control Disorders
Compulsive gambling, hypersexuality, compulsive eating — D3 mesolimbic effect; patients rarely self-report; ask directly
Class-Defining
Sleep Attacks
Sudden onset sleep without warning; counsel patients against driving; more prominent than with levodopa
Dopaminergic
Nausea and Orthostatic Hypotension
Shared with levodopa; manage with low starting dose and slow titration
Neuropsychiatric
Hallucinations and Psychosis
Mesolimbic dopamine excess; more common in elderly — levodopa preferred over agonists in patients over 65